Advances in automation and digital technologies are undoubtedly changing the nature of work. Technology creates jobs, often in unpredictable ways, but it also displaces jobs. Some of the routine tasks that make up jobs can now be automated, making some occupations obsolete and displacing workers. Workers affected by technological change can find work in alternative occupations, but research on displaced workers suggests persistent effects: they typically earn less and have worse health, including higher mortality.

Occupational segregation, therefore, potentially places men and women at different risks of job displacement from automation. Few studies consider job displacement risks by gender, much of the focus has been on the typically male-dominated manufacturing sector. By some estimates, however, women face a higher risk of having their jobs displaced by automation. Other estimates show that men are more vulnerable to potential future automation. Nevertheless, recognition of the gendered structure of the labor market suggests the need for gender-sensitive policies to help workers navigate labor market disruptions caused by automation.

Determining gender divides in automation risk

Researchers employ various methods to determine the automation potential of occupations. Some focus on the automatability of tasks that make up jobs, others estimate the automatability of whole occupations. The differing task content of jobs and occupations, and the risks attached to them may lead to varying conclusions about the risk of displacement by gender. For example, studies by McKinsey Global Institute and the Metropolitan Policy Program at Brookings argue that in the United States, men could face a higher risk of losing their jobs to automation by 2030. Analysis by the Institute for Women’s Policy Research, finds that women were more likely than men to be in occupations with both the lowest and highest risk of technological substitution between 2014-2016.

Women are more likely to gain new jobs in occupations with the lowest risk of automation

Estimates of the differential impact of automation on men and women’s jobs may vary, but researchers broadly agree that women may benefit from job growth in the least automatable fields such as health care and education. Women made up roughly 88% of nurses and home health aides and 79% percent of elementary and middle school teachers in 2014-2016. Such jobs have relatively low risk of automation, and are projected to be among the fastest growing over the next decade. However, relatively higher paying tech jobs in which women have been traditionally underrepresented are expected to grow rapidly too, potentially worsening existing gender gaps in earnings. In the absence of intentional policies, women may continue to lag in these sectors.

Policies to help workers

Government and employers will need to support and expand initiatives aimed at improving worker skills and preparing students for future jobs. But the effects of automation will affect men and women differently, so policies aimed at helping workers need to be gender sensitive. Addressing structural barriers that disproportionately disadvantage women will be crucial in helping them succeed in a dynamic labor market. Specifically, child care and paid family leave policies would help women (and men) integrate paid work with unpaid care work. In addition, increasing pathways for women into the technology and engineering sectors should also be a key policy priority. The benefit of having more women in technical fields would be twofold: it will increase the number of workers with skills that are relevant to employers, and to position women for success in jobs that use new technologies—which are expected to increase significantly.

Erick Viramontes is a joint fellow at the Brookings Doha Center (BDC) and Qatar University (QU), where he teaches at the graduate level at QU’s Gulf Studies Program. Prior to this, he was professor of international relations at the Australian National University and of political anthropology at Universidad Autónoma de San Luis Potosí in Mexico.

Erick holds a Ph.D. in Politics and International relations from the Australian National University, where he wrote a thesis about the deployment of discourses on national identity in several sites of cultural production in contemporary Qatar. He is interested in understanding how power operates in society through apparently non-political processes, especially those related with the embodiment of national and gender identities. He is also interested in looking at how social actors resist power through envisioning alternative ways to perform those same forms of identification. He is currently exploring answers to these questions by looking at the socio-political transformations taking place in the states of the Gulf Cooperation Council, especially Qatar, which are implementing projects for reform aimed to diversify their economies away from their reliance on the exports of hydrocarbons.

The first paper discussed how there are no costs, in terms of loss of economic efficiency attached to greater female political representation in a competitive electoral system. The second paper highlighted allocated efficiency associated with women representatives in countries that have gender-based quotas in their legislatures, and the reduction of incidence of Maternal Mortality.

The presentation of these papers was followed by Atishi’s insights as a political leader. She pointed out that a female politician cannot rely on intrinsic motivation alone. A more holistic view will entail an understanding of the underlying power structures in political parties. She also noted how strategic motivation (re-election) is an essential part of a democratic system. In her experience, she found that the underlying reason for rent-seeking while in office was the need for cash for re-election.

She summarised that if the ultimate objective of strategic motivation was re-election, then it would be important to understand voter preferences. Does the electorate respond to high quality governance and delivery of social and public goods—such as schools and hospitals, or do these matters not find traction in the electorate and mostly responds to cash pay-outs? It is essential to understand this demand side mechanism to forge any changes in the political landscape.

The second discussant, Mudit Kapoor, pointed out that the subjugation of women has been pervasive over time. He argued that the worst form of slavery is not when it is explicit but when it is implicit, that is, one manipulates the other into complying. He quoted esteemed philosophers— Francois Fendon (1687) & Adam Smith (1776)- to show how even enlightenment era thinkers thought a woman’s place was strictly within the domestic sphere and should not have access to too much knowledge. Kapoor concluded that in terms of gender quotas, certain human rights are ends in themselves.

Summary details and key insights of the two papers presented by Bhalotra are presented below:

Women legislators raise economic performance

Raising the share of women in India’s state legislative assemblies is not only likely to lead to better representation of women’s and children’s concerns in policy-making, it is also likely to lead to higher economic growth.

Research suggests that women favour redistributive policies and thus, have tolerance for higher taxes. This could make it plausible that, at least in the short to medium term, women politicians are less effective than men at promoting economic growth. Using comprehensive data for 4265 state assembly constituencies for the period of 1992 to 2012, the study shows that the opposite is true — women legislators not only clock in greater growth, they also lead to more efficient development outcomes.

This study overcomes two challenges that arise in answering the question of whether women politicians are good or bad for growth. These are:

a) Constituency-level data on economic activity not being available. To resolve this, the authors use satellite imagery of night luminosity which, previous work shows, is a proxy for economic performance. It was found that it is positively associated with GDP at the state level.

b)The challenge for research seeking to estimate causal effects of electing women is that constituencies where women win elections tend to be systematically different from those that elect men in ways that may be correlated with economic performance. In other words, differences between male and female legislators may spuriously reflect differences in voter preferences.

To address this challenge the authors use a previously ratified statistical approach that involves comparing male and female legislators who win against the other gender by a narrow vote margin. The results emerge from a thought experiment that asks how economic growth in a constituency would change if a male leader were replaced by a female leader, all other factors being the same.

Key insights from the paper:

Women legislators in India raise economic performance in their constituencies by about 1.8 percentage points per year more than male legislators. This means that when average growth is seven percentage points, the growth premium associated with female legislators is about 25%. To understand the mechanisms underlying this striking finding, the study explored differences between male and female legislators in:

Corruption

Efficiency

Motivation

Each of the listed factors has been associated with economic growth in developing countries. The study found evidence in favour of women in each case.

Male legislators are about three times as likely as female legislators to have criminal charges pending against them when they stand for election. The study estimated that this can explain about one fourth of the difference in growth between male and female-led constituencies.

When the authors buttress this result with estimates of actual corruption in office, measured as the rate at which legislators accumulate assets while in office, we find that this is ten percentage points lower per year among women than among men. These findings line up with experimental evidence that women are more fair, risk-averse, and less likely to engage in criminal and other risky behaviour than men.

Since economic infrastructure is an important input to growth in developing countries, the study analysed MLA performance in implementation of PMGSY, the massive federally-funded village road construction program. Authors find that male and female politicians are equally likely to negotiate federal projectsfor road building in their constituencies. However, women are more likely to oversee completion of these projects. The share of incomplete road projects is 22 percentage points lower in female-led constituencies.

Finally, separating the sample into swing and non-swing constituencies, we find that women legislators only perform better than men in non-swing constituencies.In swing constituencies, where electoral uncertainty is greater, elected men appear to exert more effort to improve economic growth. One interpretation of this is that men exhibit political opportunism while women display more intrinsic motivation.

Even if gender differences in tendencies towards corruption are intrinsic, if opportunities for corruption decline with development, it may be that women are especially effective relative to men at producing growth in less developed countries. On the other hand, to the extent that women are intrinsically more motivated in public-facing occupations such as politics, they may out-perform men in many environments.

Using event study design in a cross-country dataset, the authors examine the impact of gender quotas (instead of competitive elections in the first paper) on Maternal Mortality Rate (MMR). The hypothesis is that MMR is stubbornly high because it is a low policy priority. In terms of the Millennium Development Goals, the global community failed to meet the goal on MMR. The Sustainable Development Goals are more ambitious, and hence, there is a need for focused policy interest in the area.

Interestingly, the decline in MMR, beginning in the 1990s, is coincided by an increase in women’s representation in Parliaments. After the Beijing Convention of 1995, 21 developing countries made reservations for women in their national legislatures. This abrupt change of quotas is used to capture the causal effect on MMR.

Key insights from the paper:

The authors estimate that the introduction of quotas for women in parliament, results in a 9% to 12% decline in maternal mortality. For lower MMR we require trained birth assistance, pre-natal care, and lower teenage pregnancies. As soon as gender quotas are implemented, the authors find a structural break in the following indicators:

Increase in skilled birth attendance (8% to 10%)

Increase in pre-natal care utilisation (6% to11%)

Decline in birth rate

Increase in girls’ education
It’s critical to point out that these indicators show improvement without a parallel change in GDP, health expenditure or developmental assistance for health.

2. Without any changes in the allocated resources, either one of the two mechanisms can be at play—allocative efficiency (effective targeting of women with no loss in targeting men) versus a substitution effect (more resources for women at the cost of health expenditure on men). With further analysis, substitution effect is ruled out as the authors find that there is no variation in male mortality or that of targeting gender neutral diseases. The authors conclude that women policy makers are more effective in targeting women’s health, that is, allocative efficiency is at play.

The authors find reinforcing evidence from the period in which the United States experienced rapid declines in maternal mortality. The historical decline made feasible by the introduction of antibiotics was significantly greater in states that had longer exposure to women’s suffrage.

Hence, gender quotas can be used as an effective policy tool to meet SDG goals on gender equality and MMR.

On July 19, 2019, Brookings India hosted a Development Seminar on gender in the North East, under its Gender Secretariat initiative, which is a platform for developing and discussing research that fuels impact on policy related to gender in India.

Patricia Mukhim, veteran journalist and editor of Shillong Times, and a Padma Shri awardee, presented key insights from her book, Waiting for an Equal World: Gender in the North East, and discussed lesser known aspects of matriliny in Meghalaya.

Simi Malhotra, Director of the Centre for North East Studies and Policy Research, Jamia Millia Islamia, Namita Bhandare, award-winning journalist with nearly 30 years of reporting experience, and Karuna Nundy, Supreme Court advocate and international lawyer were the discussants. The panel discussion was chaired and moderated by Dr. Shamika Ravi, Research Director, Brookings India.

In attendance were academics, public policy experts, bureaucrats, representatives of implementation agencies and advocacy groups.

The other side of matriliny in Meghalaya

Patricia Mukhim opened her presentation by dispelling several myths about the overly romanticised concept of matriliny in Meghalaya. She pointed out that women in a matrilineal society are not necessarily better off and nor are they naturally empowered. Mukhim highlighted a number of stark statistics such as 53% teenage pregnancies in Meghalaya (third only to 61% in Mizoram & 64% in Goa). Given the matrilineal organisation of the society, she highlighted the plight of young pregnant-drop-out girls who by default have to support and run their families single-handedly; she pointed out that often such girls are abandoned and their children land up on the streets.

Dr. Malhotra used folktales set in matriarchal Meghalaya to bring out the social anxieties around an alternative form of family organisation. She said, “it’s important to pay attention to the incipient messages which are embedded in folktales—of how gender itself is coded within the narrative rapporteurs which come from the north east”. Namita Bhandare bought to the table a number of key statistics that highlighted poor political participation of women in the Northeast. Karuna Nundy spoke about the need to have consultative, essentially representative, methods of policy formulation. Dr. Shamika Ravi focused on the key aspects of public policy in the Northeast, including education, health, property rights, political participation and developmental spending.

Some of the key insights from the panel discussion are presented under:

Political participation

Even though Northeastern states witness equal electoral participation by women in terms of voters (Table 1), the same does not translate into either rich candidature of women or elected representatives (Table 2 & Figure 1). Even in matriarchal Meghalaya, while women volunteers are extensively used for canvassing, they are not encouraged to participate in politics as candidates.

Table 1: Political Participation of Women as Electors and Voters

State/Union Territories

Year Of Last General Elections

Registered Women Electors (%)

Women Votes Polled (%)

Women Votes Polled As % Of Registered Women Elector

Arunachal Pradesh

2014

50.10%

49.80%

78.9

Assam

2016

48.26%

51.15%

90.38

Manipur

2017

51.03%

51.83%

87.99

Meghalaya

2018

50.41%

50.68%

87.23

Mizoram

2018

50.98%

50.65%

80.09

Nagaland

2018

49.22

49.50%

86.08

Sikkim

2014

48.55%

47.15%

81.4

Tripura

2018

49.15%

49.16%

90.4

Source: Election Commission of IndiaAuthor calculations: Shamika Ravi

Table 2: Women as Candidates and Elected Representatives

State/Union Territories

Year of Last General Elections

% of Women Contestants

% Seats Won By Women

Arunachal Pradesh

2014

3.87

3.3

Assam

2016

8.55

6.34

Manipur

2017

4.13

3.33

Meghalaya

2018

8.86

5

Mizoram

2018

8.61

0

Nagaland

2018

2.65

0

Sikkim

2014

9.09

9.4

Tripura

2018

8.08

5

Source: Election Commission of IndiaAuthor calculations: Shamika Ravi

Figure 1

Author calculations: Shamika Ravi

While Mizoram has never elected a female member Parliament, perhaps the starkest example of the lack of female representation comes from Nagaland that has failed to elect a single female MLA in 55 years of statehood. Rano Shaiza, a member of United Democratic Party, was the first and only woman in this state who was elected to Lok Sabha in 1977. Recent years have witnessed widespread violence in Nagaland over the government’s decision to introduce 33% reservation for women in civic body polls.

Further, within matrilineal Meghalaya, traditional socio-political institutions like the Dorba-Shnong (village council) do not allow women to become village heads— the Rangbah-Shnong (headman) can only be a man. There is a clear disconnect between the matrilineal space of a house and that of public institutions of governance.

The panel was of the opinion that perhaps the solution lies is North Eastern women coming together as a voting blocks that support women candidates. Malhotra said that, “the paternalistic baggage of ethnicity, and hence the ethnic divide within the north eastern states, has been an impediment in this direction. At the grassroots level, the women’s movement in the north east and associated synergies and outlets of solidarity have to be explored”.

Landlessness

The youngest daughter of the family, the Ka Khadduh, inherits all ancestral property. This shows up in survey data like the NFHS-4 where a greater percentage of Meghalayan women indicate ownership of land than the average Indian woman (Table 3). However, increasingly the non-inheriting daughters find preference in the marriage market. This indicates bad health of the social institution as well as that of the defined property rights. An asset is truly empowering when its innate value is economically transactable, and in the absence of property rights, this feature of liquidity in assets is inherently missing.

Table 3: Percentage Landlessness by Gender

States/ Union Territories

Women

Men

Arunachal Pradesh

0.5

0.22

Assam

0.55

0.21

Manipur

0.63

0.45

Meghalaya

0.58

0.53

Mizoram

0.85

0.7

Nagaland

0.75

0.4

Sikkim

0.79

0.25

Tripura

0.66

0.55

All India

0.72

0.5

Source: NFHS 4Author calculations: Shamika Ravi

The socio-economic caste census conducted in 2011 revealed that 76% of rural Meghalaya is landless. A matrilineal order of society implies that land is owned by women, which leads us to conclude that landlessness in growing amongst women as well.

A cadastral survey is the need of the hour—a tribal society is built around equitable resource sharing and egalitarian social constructs, but in terms of distribution of real assets, this no longer holds true.

Common property rights

On a related note, there is a need to define common property rights as well. There is ample international evidence around extractive governance and poor institutional health in resource-rich lands. Mukhim discussed how there is rampant extraction of coal and limestone mines in Meghalaya. However, in recent years, in the absence of well-defined common property rights, even water sources have been privately leased out. Apart from the market distortion and poor equilibrium such a setting leads to, it causes needless increase in drudgery for women who have to go fetch water from distant sources.

Access to credit

Women in the Northeast not only extensively participate in the labour force compared to rest of India but also tend to own their enterprises (Table 4 and 5). Access to credit becomes a key factor in the success and growth of their micro and medium enterprises.

Mukhim noted that of the 4.6 crore population of Northeastern states, only 22 lakh have access to microcredit, mostly concentrated around Assam. Table 6 shows the linkages of self-help groups with banks—rural and co-operative. It is clear that compared to the rest of India, the Northeast is substantially lagging behind.

Table 6: Linkages of Self Help Groups: Loans

States/ UT’s

Number of Self Help Groups Per Lakh Womenlinked to Regional Rural Banks

Number of Self Help Groups Per Lakh Womenlinked to Co-operative Banks

Arunachal Pradesh

2

5

Assam

70

0.77

Manipur

18

0

Meghalaya

4

0.58

Mizoram

22

3.5

Nagaland

1.5

0

Sikkim

0

2

Tripura

5.6

3

All India

85

34

Source: NABARD as of 31st March 2017Author calculations: Shamika Ravi

Financial inclusion is an important policy lever that has shown the ability to translate into tremendous socio-economic impact. Bangladesh is a worthy example that policymakers should try replicating and tailoring it to the needs of the tribal Northeast.

Development and governance institutions

Ten percent of all developmental spending of central ministries was earmarked for the development of the Northeast. Ravi noted that the Ministry of Development of Northeast Region (M-DONER) and the Northeast Council should look at each state in the Northeast as a separate entities in order to develop nuanced development plans tailored to the states’ individual needs.

Author calculations: Shamika Ravi

Assam, Meghalaya, Tripura and Mizoram are governed under Schedule 6 of the Constitution of India. The tribal areas of these states have been constituted as autonomous districts. Each autonomous district has a district council consisting of 30 members, of whom four are nominated by the Governor and the remaining 26 are elected on the basis of adult franchise. Each autonomous district has a separate regional council. The regional and district council administer the area under their jurisdiction and make laws on certain specified matters like land, forest, canal water, shifting cultivation, village administration, inheritance of property, marriage and divorce, social customs and so on. All such law requires the assent of the governor. [1]

“When the provisions of the 73rd Amendment (Panchayati Raj Institutions) on the powers, scope of function and financial support for the exercises of the powers and discharge of the responsibilities by the Panchayat bodies are compared with those attached to the District Councils under the Sixth Schedule, it is found that while the District Councils have several regulatory powers subject to state government control, the Panchayats are in more advantageous position in respect of developmental functions”, notes legal researcher Dipanjan Roy Chaudhury.[2]

The slow pace of development of the Northeast and the lack of female representation in district councils is a troubling trend. Rethinking how to harmonise the idea of a gender representative village/district councils that allow for the developmental function of Gram Panchayats through Gram Sabhas is advised.

Crimes and Unregulated Tourism

Incidence of crimes against women (CAW) in the Northeast has closely followed the all-India rate of incidence of CAW. In the calculation of CAW, we have considered registered cases of rape, kidnapping and abduction, dowry deaths, cruelty by husband and his relatives, assault with intent to outrage modesty and insult to the modesty of women. Further, we have calculated incidence by using mid-year population estimates of state-wise female population provided by the Registrar General of India. These population estimates are also used by the National Crimes Records Bureau.

Author calculations: Shamika Ravi

Figures include: Rape, Kidnapping and Abduction, Dowry Deaths, Cruelty by husband and his relatives, assault with intent to outrage modesty and insult to the modesty of women

We can clearly see that Assam has a very high incidence of CAW per lakh women. However, seeing how the seven states of Northeast combined incidence of CAW closely map the all-India incidence, we find that women are no safer in these tribal/ matriarchal settings. There is a clear case for improving the law and order situation.

Further, Ms. Mukhim noted that given the remote and scenic nature of these states, there is a case for increasing state GDP through tourism, by developing clear policies around the sector. So far the sector remains unregulated and a number of negative social spill-overs have been reported. In other words, to boost the tourism sector, there is a need to improve the law and order situation as well as put a leash on unregulated tourism.

When Tucker Carlson agrees with Elizabeth Warren, it is worth taking notice. At a recent conservative conference, Mr. Carslon described Sen. Warren’s book, The Two Income Trap as “one of the best books” he had read on economic policy. “The single biggest change to our society,” he went on, “was the moment where it became impossible for the average person to support a family on one income.”

There is a lot to quibble about here, not least how precisely to define “impossible,” “average,” and “support.” But the basic fact is right. The question is what conclusion to draw. As a populist poster-boy for the right, Mr. Tucker is likely to conclude that the solution is for women to return to home and hearth. In fact, the opposite is true.

To bolster middle class family incomes, women are likely to have to work more, rather than less. This has costs in terms of family time, leisure, but it is a fact of modern economic life. Better to help families cope with it–through paid leave policies, flexible working arrangements, affordable childcare, and fair scheduling rules–than to rail against it.

Over the last few decades, the wages of men with less than a college education have not been growing, while the wages of women have risen across the board, though much more so at the top. What this means is that the motherhood wage penalty has become a family wage penalty.

One obvious reason is that women still take on more childcare responsibilities than fathers. To that extent, the wage “penalty” is in part a reflection of family preferences. To the extent that mothers want to stay at home with their kids or work part-time, there will be economic consequences. These costs are less for affluent couples, since earnings for both men and women with high levels of education have been rising.

Meanwhile the mothers and fathers in middle class families increasingly have to combine paid work with caring for their children. Right now, that balancing act can be a difficult one. Employment legislation and workplace culture are lagging the realities of modern family life. Three issues ought to be top of policymakers’ minds: paid leave, childcare, and fair scheduling.

Second, when both parents are at work, access to affordable, high-quality childcare is vital. Three in five parents who say they are struggling financially report that the cost of childcare has caused a “serious problem,” according to a survey from the Robert Wood Johnson Foundation.

It is not for the government to dictate how families decide how to balance work and care, and how mothers and fathers share these tasks between them. Nobody, to use an old feminist phrase, can “have it all.” But it is for the government to help to ensure that middle class families can get more than they currently do. The economy is missing out on the full value of the skills of millions of mothers. Middle class families are missing the earnings of women on which they now rely. Helping working mothers is not just about gender equality. It is about restoring the middle class.

]]>20190821 Foreign Policy Tamara Cofman Witteshttps://www.brookings.edu/media-mentions/20190821-foreign-policy-tamara-cofman-wittes/
Wed, 21 Aug 2019 15:23:56 +0000https://www.brookings.edu/?post_type=media-mention&p=608733By Kevin Huggard]]>The gender and racial diversity of the federal government’s economistshttps://www.brookings.edu/events/the-gender-and-racial-diversity-of-the-federal-governments-economists/
Tue, 13 Aug 2019 18:59:15 +0000https://www.brookings.edu/?post_type=event&p=607570The lack of diversity in the field of economics – in addition to the lack of progress relative to other STEM fields – is drawing increasing attention in the profession, but nearly all the focus has been on economists at academic institutions, and little attention has been devoted to the diversity of the economists employed by the federal government, including the Federal Reserve System.

On Monday, September 23, the Hutchins Center on Fiscal & Monetary Policy will host a conversation on why diversity among economists matters and how to recruit and retain more women and underrepresented minorities.

The event will open with remarks from Janet Yellen, former Chair of the Federal Reserve and current distinguished scholar in residence at Brookings, followed by the debut of a new Hutchins Center report on the current state of diversity among Ph.D. economists employed by the federal government and the Federal Reserve. That will be followed by a conversation among those leading efforts to promote diversity in the profession. The discussion will explore what we know about diversity within economics, as compared to other STEM fields; highlight strides the Federal Reserve has made in this area and share lessons learned; and make note of what has been and what still may be done to diversity the pathways of underrepresented groups in economics. Panelists include Amanda Bayer of Swarthmore, Judith Chevalier of Yale, Kaye Husbands Fealing of Georgia Tech, Ellen Meade of the Federal Reserve Board, Zina Sutch of the Office of Personnel Management and Susan Collins of the University of Michigan.

Gender discrimination in access to healthcare has not been systematically studied in India or many other developing countries. This is primarily due to a lack of reliable data. In this paper, we use extensive data collected on clinical appointments from a large public-funded tertiary care hospital with a robust hospital information system to study the level and extent of gender discrimination in access to healthcare. We used data on clinical appointments from 2,377,028 outpatients to analyse the likelihood of a male patient visit compared with a female patient visit to the hospital and its variation with respect to distance from the hospital and the age of the patient.

Previous studies on gender discrimination in developing countries have largely focused on the excess mortality of female patients as seen in low population ratios of women to men to explain the issue of missing women. This paper furthers these studies by assessing gender discrimination experienced by women in access to healthcare. There have been a handful of small sample studies on gender bias in access to healthcare in select patient groups or for specific medical conditions; however, this study uses extensive data across a wide spectrum of patient groups and medical conditions to examine the gender discrimination in access to healthcare.

The objective of the study was to investigate gender discrimination in access to healthcare and its relationship with the patient’s age and distance from the healthcare facility. The observational study was based on outpatient data from the All India Institute of Medical Sciences, a large referral hospital in New Delhi, India.

The researchers used estimates from the logistic regression to compute sex ratios (male/female) of patient visits with respect to distance from the hospital and age. Missing female patients for each state—a measure of the extent of gender discrimination—were computed as the difference in the actual number of female patients who came from each state and the number of female patients that should have visited the hospital had male and female patients come in the same proportion as the sex ratio of the overall population from the 2011 census.

Of 2377028 outpatient visits, excluding obstetrics and gynaecology patients, the overall sex ratio was 1.69 male to one female visit. Sex ratios, adjusted for age and hospital department, increased with distance. The ratio was 1.41 for Delhi, where the facility is located; 1.70 for Haryana, an adjoining state; 1.98 for Uttar Pradesh, a state further away; and 2.37 for Bihar, the state furthest from Delhi. The sex ratios had a U-shaped relationship with age: 1.93 for 0–18 years, 2.01 for 19–30 years, and 1.75 for 60 years or over compared with 1.43 and 1.40 for the age groups 31–44 and 45–59 years, respectively. The study estimates that there were 402,722 missing female outpatient visits from these four states, which is 49% of the total female outpatient visits for these four states.

The study’s findings reveal gender discrimination in access to healthcare, which was worse for female patients who were in the younger and older age groups, and for those who lived at increasing distances from the hospital.

Northern Nigeria, home base for terrorist organization Boko Haram, has long been plagued by extremist violence toward girls. State and federal government, as well as the international development community, tout entrepreneurship and vocational skills acquisition programs as a panacea to build girls’ resilience and are rolling out skills acquisition programs. In these programs, girl survivors learn basic business, planning, and vocational skills to rebuild their lives and cope with the violence, abduction, and crisis they experience.

Many gender experts and donors assume that acquiring skills will generate income and that increased income will build girls’ resistance against child, early, and forced marriage. However, the fact that these skills programs are not evaluated, coupled with the absence of curriculum standardization in the government and donor programs offered, results in interventions with no verifiable evidence of effectiveness.

Indeed, through two girls’ education projects in Northern Nigeria, my colleagues and I found that entrepreneurship and vocational skills acquisition are not enough to empower girls or strengthen their capacity to cope with crises in the region. Using an implementation research design, the development Research and Projects Center (dRPC)—a Nigerian NGO that I founded—tested the effectiveness of two vocational skills acquisition models that blended basic literacy and life skills components. The first targeted 50 girls in government secondary schools in Nigeria’s Northwest, and the second targeted 50 displaced girls in Nigeria’s Northeast. The secondary school program built upon the compulsory trade subjects in Nigeria’s new national curriculum and was implemented in after-school skills clubs over a six-month period. The program for displaced girls was a blended mix of vocational and life skills implemented in the pastoral setting of Gombe over a six-month period.

What did we learn from evaluating these models?

We learned that a skilled girl is not an empowered girl. Without psycho-social support and life skills training integrated into vocational skills programs and post-training economic support, skills interventions do not transform girls’ lives. Girls who completed skills courses were soon confronted with the reality of skills gained not matching with the demands of the workforce and with prohibitively high market entrance costs. No girls in either program accessed financial or emotional support outside the project. So, while the federal and state governments in Nigeria are rolling out new economic empowerment programs linking micro-finance initiatives with markets, enterprise, technology, and business innovation, these are not being extended to girls’ skills acquisition initiatives. Without a bridge to new government programs, girls do not have the opportunity to apply the skills learned.

We also learned that girls face security challenges traveling to training centers. They are so troubled about their futures that learning outcomes are negatively impacted. For example, girls in the Northeast training center repeatedly expressed desire to drop out from the skills classes and girls in secondary schools in the Northwest pleaded for after-school club activities to be incorporated within school hours due to fear of abduction and rape. In such cases, we found that counseling and mentoring by female instructors who recognized the toll that psychosocial trauma continued to have on the girls’ day-to-day lives made a positive difference. Female counselors were particularly adept at teaching girls important life skills such as negotiating gender barriers while remaining committed to economic empowerment.

Our research validates the effectiveness of program designs that blend counseling, mentoring, and life skills components led by female instructors and counselors. It also points to the necessity of incorporating a psychological trauma component into life skills modules. Our study highlights that, without mentorship and access to additional capital, skills acquisition programs alone are unlikely to empower girls. And perhaps just as importantly, these programs must make girls’ personal experiences and fears a central consideration during their design and implementation.

Executive Summary

The development Research and Projects Centre (dRPC) set out to investigate a much-touted assumption in the child, early, and forced marriage community: that acquiring vocational skills offers girls a pathway to empowerment, agency, and poverty alleviation. The dRPC also set out to test the assumption that empowerment and agency contribute to building girls’ resilience and resistance to child, early, and forced marriage. The center sought to explore these assumptions in the context of two ongoing projects it was conducting: Conjugal Slavery in War (CSiW) and Partnership for Innovation and Practice in Secondary Education (PSIPSE).

The research carried out followed a retrospective research design using implementation research methodology and employing both quantitative and qualitative data collection tools. The research was rolled out through two customized skills acquisition programs integrated in existing dRPC interventions. The six-month skills acquisition pilots were implemented in Northern Nigeria, a region of the country with the highest rates of early marriage, where the most recent data shows that 36 percent of girls are married before the age of 15.

Fifty girls participated in the vocational skills acquisition training in a government secondary school in the Northwest state of Kano, which was part of the PSIPSE project. Another fifty girls, displaced by the insurgency in the Northeast, participated in training and counseling provided by a nonprofit organization, Science Village Gombe, in Gombe State.

As this working paper notes, the study found that while girls in both study sites acquired new skills, derived support and relief, and learned to cope with their anxiety, exposure to the interventions failed to change the girls’ acceptance of marriage as their destiny. Moreover, the fact that trauma associated with forced marriage in the Northeast was intertwined with wider trauma related to abject poverty, insurgency, and displacement, suggests that acquiring skills alone does not build resilience to the trauma of abduction and forced marriage. In the Northwest, the contexts of insecurity, a failing secondary school system, and a contracting informal economy make economic empowerment unattainable for girls.

Without strong guidance and counseling units within the school system, and without access to capital, markets, and mentorship, it is doubtful that skills alone can empower girls or form the basis of an alternative to early marriage. This study recommends a holistic girls’ empowerment program design in which vocational skills are an important but not singular component. Such a program design will build on life skills and counseling to address psychological trauma. Also important will be extended timelines for interventions, integration within government small- and medium-scale poverty alleviation programs, and post-intervention follow-up mentoring support. A robust monitoring and evaluation framework must support learning and redesign of such interventions.

Note: All girls who participated in the skills training program and research activities gave their informed consent. For those under the age of 18, additional consent was obtained from school authorities, guardians, and/or host families. Participation was voluntary, girls could leave at will, and all identifying information was kept confidential. Photos included in this report have been granted permission by the girls for public distribution.